Pathophysiology - Chronic With time, genes are activated allowing increases in both left ventricular cavitary dimensions and wall thickness – described as eccentric hypertrophy or “cor bovinum” A very large total stroke volume allows forward output to remain normal; clinical features of wide pulse pressure are present The dilated ventricle accommodates larger volumes at a lower filling pressures, and pulmonary congestion is generally absent Ejection fraction remains normal during this phase May remain compensated for decades